Saunders ' Question Compends 















iSSEN'J'MIS OF ^ 

'^'^'AMINATION OF UrINE 

Lawrence Wolff. M.IJ, 



.W85 



/b f 



SAUNDERS' QOESTION-eOMPENDS, 

OPINIONS OF THE PRESS. 

Extract from London Lancet, July 6tli, 1889. 

"Useful Adjuncts to Systematic Keading.— It is fortunate for the Student that 
these books should be undertaken— by competent hands, by men who, being them- 
selves engaged in teaching, know where the subjects require most elucidation, and 
who, moreover, are careful to be accurate in their statements/* 

Extract from Nashville Journal of Medicine and Surgery, 
December, 1889. 
Morris' Materia Medica. — "A most excellent vade mecum for students 3 its 
arrangement in Questions and Answers is a decided advantage.'* 

From College and Clinical Record, September, 1889. 
Semple's Pathology and Morbid Anatomy. — "A small work upon Pathology 
and Morbid Anatomy, that reduces such complex subjects to the ready comprehension 
of the student and practitioner, is a very acceptable addition to medical literature. All 
the more modern topics, such as Bacteria and Bacilli, and the most recent views as to 
Urinary Pathology, find a place here, and in the hands of a writer and teacher skilled 
in the art of simplifying abstruse and difficult subjects for easy comprehension, are 
rendered thoroughly intelligible. Few physicians do more than refer to the more 
elaborate works for passing information at the time it is absolutely needed, but a book 
like this of Dr. Semple's can be taken up and perused continuously to the profit and 
instruction of the reader." 

Extract from Buffalo Medical and Surgical Journal, January, 1890. 
Morris' Materia Medica.-^" Presented in a unique and attractive shape, and 
cannot fail to impress the mind in a lasting manner. It is a fine specimen of book 
art." 

Extract &om Cleveland Medical Gazette, December, 1889. 
Hare's Physiology.— " One of the best works on the subject that has come under 
our notice ; of great help to the earnest student. Such books are ever valuable." 



Extract from SouthfernJD^JjLfui'iiia Practitioner, March, 1889. 

AsTTTQ-N^^g ^'"-'"' —'ii Willi ^■ii^^^^^^^^BMM^MtokT^^^ IP ni~.yifi.QrA7-Ai f>f condcnsation and 
completen^l 



recall somflr. 
escape tl£^ 

Morris^ 
leaves not] 
valuable sti 



LIBRARY OF CONGRESS. 



Sh. 



UNITED STATES 




ERICA. 



)ner in serving to 
ch will frequently 



gaiter of this book 
laetitioner. It is a 



SAUNDERS' OnESTION-GOMPENDS, 

OPINIONS OF THE PRESS. 

Extracts from Annals of Surgery, June, 1889. 

"They may be used to no little advantage by the practitioner, in presenting tbe 
main facts of his professional work, in a suitable form for ready reference and com- 
plete classification. The form of Questions and Answers is peculiarly qualified to 
secure definiteness of information. Dr. Nancrede has given us a work far more exten- 
sive in its character than anything of the kind. 

The Medical Student who shall have mastered its contents, will certainly have 
acquired all the essential points of Anatomy." 

" The Essentials of Physiology are most clearly and comprehensively outlined by 
Dr. Hare." 

Wolff's Chemistry. — "The questions are distinctly stated, and the answers, 
framed with marked clearness, are fully up to the times." 

"Martin's Surgery, comprehensive in scope j it is an unusually satisfactory con- 
densation." 

Ashton's Obstetrics. — "The book presents all the essentials of its subjects, and 
much other valuable matter." 

Extracts from University Medical Magazine. 

Martin's Surgery. — "The most pronounced opponent of the system of 'Quizzing' 
in vogue at the present day^ could find no ground for objections to this excellent little 
book, which cleverly combines all the merits of condensation, while avoiding the errors 
of superficiality and inaccuracy with which such Compends commonly abound. It is a 
pleasure to be able to recommend the book absolutely and without reservation, as thor- 
oughly fulfilling the purpose for which it was written, and, so far as Surgery is con- 
cerned, decidedly the best of its kind with which we are acquainted." 

Nancrede's Anatomy. — "To learn Anatomy is not merely to remember the names 
of muscles,, arteries and nerves, but to study their origin and insertions, their course 
and relations, and their distribution. Dr. Nancrede has kept this necessity constantly 
in mind, and the student who masters the details of this littie book in connection with 
conscientious work in the dissecting room, will find it a help for which his tired mem- 
ory will often sincerely give thanks. The questions have been wisely selected, the 
answers are accurate and concisely constructed, >>ut still with-^sufficient detail to free 
them from the criticism that they are mereij listS of names." 

Extract from New York Medical Escord, May, 1889. 
" Saunders' Series of Student's Manuals, arranged in the form of Questions and 
Answers, are concise, without the omission of any essential facts. Handsome binding, 
good paper and clear type increase their attractiveness." 

Extract from St. Joseph's Medical Herald, March, 1889. 

" Wolff's Chemistry. — A little book that explains, clearly and simply, the most 
difficult points in Medical Chemistry, so that this need no longer be the great bugbear 
of a medical student's efforts." 



Chicago Medical Times, 
May, 1889. 

" Ashton's Obstetrics 
embodies the whole sub- 
ject in a nut-shell. We 
cordially recommend it 
to our readers." 

Southern California Prac- 
titioner, Nov., 1889. 

"Morris' Materia Med- 
ica. — We know of no bet- 
ter complement for the 
busy medical student to 
a course of lectures on 
Materia Medica than the 
above book." 

Medical and Surgical Re- 
porter, February, 1889. 

"Martin's Surgery 
contains all necessary 
essentials of modern 
surgery in a compara- 
tively small space. Its 
style is interesting and 
its illustrations admira- 
ble." 

From Journal of the 
American Medical As- 
sociation, Nov. 23d, 
1889. 

** Hare's Physiology.— 
An excellent work ; ad- 
mirably illustrated. 
Well calculated to light- 
en the task of the over- 
burdened undergradu- 
ate." 

Pharmaceutical Era, 
January, 1890. 

"Wolflfs Chemistry.— 
The Author, from his 
intimate acquaintance 
with medical students, 
appreciates their neces- 
sities in the line of chem- 
ical knowledge; the 
scope of the work is cer- 
tainly equal to that of 
the best course of lec- 
tures on medical chem- 
istry, which it will also 
Taluably supplement." 



Extract from London Lancet, July 
6th, 1889. 

"Useful Adjuncts to Systematic 
Reading. — It is fortunate for the Stu- 
dent that these books should be un- 
dertaken by competent hands, by 
men who, being themselves engaged 
in teaching, know where the sub- 
jects require most elucidation, and 
who, moreover, are careful to be 
accurate in their statements." 



NOW MEADY. 



Saunders' (juestion-Compends 

Nos. 10 and II. 



Price; Cloth, $1.00 ; Interleaved, for 
Notes, $1.25. 

No. 10. Essentials of Gyn- 
aecology. Profusely Il- 
lustrated. By Edwin B. 
Cragin, M. D. 

No. II. Essentials of Dis- 
eases of the Skin. 75 

Illustrations. By Henry 
W. Stelwagon, M. D. 



Price: Cloth, $2.00, net : Interleaved, 
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SYLLABUS OF 

OBSTETRICAL LECTURES 

IN THE MEDICAL DEPARTMENT 
OF THE UNIVERSITY OF PENNSYLTANIA. 

By Richard C. Norris, M.D. 



Price: Cloth, 75 cts.; Interleaved, 
for Notes, $1.00. 

EXAMINATION OF THE URINE, 

For Clinical Purposes. 

Colored Plate and Numerous Other 

Illiistraiions. 

By Lawrence Wolff, M.D. 



New York Medical Record, May 25th, 
1889. 

"Saunders' Question-Compends 
are all arranged in the form of ques- 
tions and answers, and are concise, 
without the omission of any essen- 
tial facts. Handsome binding, good 
paper and clean type increase their 
attractiveness." 



Cincinnati Medical News, 
January, 1889. 

" Wolff's Chemistry. — 
A little work that can 
be carried in the pocket, 
for ready reference in 
solving difficult prob- 
lems." 



Indiana Medical Journal, 
December, 1889. 

" Semple's Pathology 
and Morbid Anatomy.— 
An excellent compend 
of the subject from the^ 
points of view of Green 
and Payne. 



American Practitioner 
and News, February 
16th, 1889. 

"Nancrede's Anat- 
omy. — For self- quizzing 
and keeping fresh in 
mind the knowledge of 
Anatomy gained at 
school it would not be 
easy to speak of it in 
terms too favorable." 



Gaillard's Medical Jour- 
nal, November, 1889. 

" Morris' Materia Med- 
ica. — The very essence 
of Materia Medica and 
Therapeutics boiled 
down and presented in 
a clear and readable 
style." . 



Medical and Surgical Re- 
porter, January 26th, 
1889. 

"Ashton's Obstetrics. 
— A work thoroughly 
calculated to be of ser- 
vice to students in pre- 
paring for examina- 
tion." 



PRICE: Cloth, $1.00; Interleaved, for Taking Notes, $1.25. 

Saunders' Question-Compends. 

Arranged in the form of Questions and Answers* 

JT7HE ADVANTAGE OF QUESTIONS AND ANSWERS.— The usefulness of arranging the 
A sulijects in the form of questions and answers, will be apparent, since the student, in reading 
the standard works, often is at a loss to discover the important points to be remembered, and is 
equally puzzled wh^n he attempts to formulate ideas as to the manner in which the questions could 
be put in the examination- room. 

No. I.— Essentials of Physiology, second Edition. Revised and 
greatly enlarg-ed. By H. A. Hare. M.D., Demonstrator of Therapeutics and Instructor 
in Physical Diagnosis in the Medical Department, and Instructor in Physiology in the Biological 
Department, of the University of Pennsylvania, etc., etc. 

No. 2. — Essentials of Surgery, containing also. Surgical Landmarks, Minor and 
Operative Surgery, and a (Complete Description, together vnth full Illustration of the Handkerchief and 
Boiler Banduge. Second Edition, witli ninety Illustrations. By Edward 
Martin, M.D., Instructor in Operative Surgery and Lecturer on Minor Surgery, University of 
Pennsylvania; Surgeon to the Out- Patients' Department of the Children's Hospital, and Surgical 
Registrar of the Philadelphia Hospital, etc., etc. 

No. 3. — Essentials of Anatomy, including visceral Anatomy, -basej) uponthe last 
EDITION OF Gray. (Second Edition. Over three hundred and fifty pages, with one hun- 
dred and seventeen Hlustrations. By Chas. B. Nancrede, M D., Professor of Surgery and 
Clinical Surgery in the University of Michigan, Ann Arbor; Corresponding Member of the 
Royal Academy of Medicine, Rome, Italy ; Late Surgeon Jeflerson Medical College, etc., etc. 

No. 4. — Essentials of Medical Chemistry, organic and inorganic, containing 
also Questions on Medical Physics, Chemical Physiology, Analytical Processes, Urinalysis and 
Toxicology. By Lawrence Wolff, M.D., Demonstrator of Chemistry, Jefferson Medical (College ; 
Visiting Physician to German Hospital of Philadelphia; Member of Philadelphia College of 
Pharmacy, etc., etc. 

No. 5.— Essentials of Obstetrics, illustrated. By W. Easterly Ashton, M.D., 
Demonstrator of Clinical Obstetrics in the Jefferson Medical College, and Chief of Clinics for 
Diseases of Women in the Jefferson Medical Hospital, etc., etc. 

No. 6.— Essentials of Pathology and Morbid Anatomy, illustrated. ByC. 

E. Armand Semple, B.A., M.B. Cantab., L.S.A., M.R.O.P. Lond., Physician to the Northeastern 
Hospital for Children, Hackney; Professor of Vocal and Aural Physiology and Examiner in 
Acoustics at Trinity College, London, etc., etc. 

No. 7.— Essentials of Materia Medica, Therapeutics and Prescription 

Writing. By Henry Morris, M.D., late Demonstrator, Jefferson Medical College; Fellow 
College of Physicians, Philadelphia; Co-Editor Biddle's Materia Medica; Visiting Physician to 
St. Joseph's Hospital, etc., etc. 

Nos. 8 and 9. — Essentials of Practice of Medicine. (Double number, over 

five hundred pages.) By Henry Morris, M.D. With an Appendix on Urinary Analysis by 
Lawrence Wolff, M.D. Profusely Illustrated. (In preparation.) 

No. 10.— Essentials of Gynaecology, with numerous illustrations. By Edwin b. 
Cragin, M.D., Attending Gynascologist, Roosevelt Hospital, Out-Patients' Department; Assistant 
Surgeon, New York Cancer Hospital, etc., etc. 

No. II. — Essentials of Diseases of the Skin, illustrated. By HenryW. stel- 

WAGON, M.D., Physician to Philadelphia Dispensary for Skin Diseases; Chief of the Skin Dispen- 
sary in the Hospital of University of Pennsylvania; Physician to Skin Department of the Howard 
Hospital; Lecturer on Dermatology in the Women's Medical College, Philadelphia, etc., etc. 

No. 12.— Essentials of Minor Surgery and Bandaging, with an Appendix 

on Tenereal Diseases. Illustrated. By Edward Martin, M.D., author of the " Essen- 
tials of Surgery," etc. (In preparation ) # 

No. 13,— Essentials of Forensic Medicine. Profusely illustrated. By armand 

Semple, M.D., author of " Essentials of Pathology and jyiorbid Anatomy." (In preparation.) 

No. 14.— Essentials of the Refraction and the Diseases of the Eye. illus- 
trated. By Edward Jackson, A.M., M.D., Professor of Diseases of the Eye in the Philadelphia 
Polyclinic and College for Graduates in Medicine; Member of the American Ophthalmological 
Society; Fellow of the College of Physicians of Philadelphia; Fellow of the American Academy 

of Medicine, etc., etc.; and Essential Diseascs of the Nose and Throat, illustrated. 

By E. Baldwin Gleason, S. B., M.D., Assistant in the Nose and Throat Dispensary of the Hospital 
of the University of Pennsylvania; Assistant in the Nose and Throat Department of the Uniun 
Dispensary; Member of the German Medical Society, Philadelphia Polyclinic Medical Society, 
etc., etc. (In preparation.) 



Scale of Urinary Colors, according to Vogel. 













I. 
PALE YELLOW. 












II. 
LIGHT YELLOW. 












Ill, 
YELLOW. 












IV. 

REDDISH YELLOW. 












V. 

YELLOWISH RED. 












VI. 

RED. 






VII. 

BROWNISH RED. 












VIII. 

REDDISH BROWN. 










M^mxj-M:P':-:.:..^- 


IX. 

BROWNISH BLACK. 









THE 



EXAMINATION OF URINE, 

CHEMICAL AND MICROSCOPICAL, 



FOB 

CLINICAL PURPOSES. 



AREANGED IN THE FORM OF 

QUESTIONS AND ANSWEKS. 



LAWRENCE WOLFF, M.D., 

PHYSICIAN TO THE GERMAN HOSPITAL OF PHILADELPHIA; DEMONSTRATOR OF CHEMISTET, 
JEFFERSON MEDICAL COLLEGE, ETC. 



COLORED PLATE, 
AND NUMEROUS ILLUSTRATIONS, 




PHILADELPHIA: 
W. B. SAUNDERS, 

913 Walnut Street. 
London : Henry Renshaw. Melbourne : Georg^e Robertson & Co. 

1890. 




-^^'A 

\i^^ 



Entered according to Act of Congress, in the year 1890, by 

W. B. SAUNDERS, 

In the Office of the Librarian of Congress, at "Washington, D. C. 



WM. F. FELL & CO., 
Electrotypers and Printers, 

1220-24 sansom st., philadelphia. 






KJ 



PREFACE 

^' 

The favorable reception accorded to my little book on ' ' The Essen- 
tials of Medical Chemistry," together with a wish expressed by 
many of its readers that it should also contain a special part on 
urinology and urinalysis, have caused the preparation of this little 
volume on ' ' The Examination of Urine, Chemical and Microscopical, 
for Clinical Purposes." 

As its scope has a more clinical than purely chemical bearing, it 
rwas thought best to present it in separate form rather than as part 
of a work on medical chemistry. It is intended as an aid for the 
student in his studies on this subject, more so than as a manual for 
his laboratory practice in chemistry. 

The. author trusts that as such it will be a welcome friend to the 
student and help him to master the essentials of this branch of 
medical science, which is of such great importance in the study of 
disease. 

L. W. 

Philadelphia, Pa., 

333 South Twelfth St., 
February, 1890. 



LIST OF ILLUSTRATIONS. 



PAGE 

Vogel's Scale of Urinary Colors, Frontispiece 

Urinometer, 21 

Urea and Urea Nitrate, 23 

Uric Acid, 29 

Acid-Sodium Urate, 30 

Triple-phosphate and Ammonium Urate, .30 

Hippuric Acid, 31 

Pus Corpuscles and Epithelial Cells, 40 

Blood Corpuscles, 42 

Teichmann's Hsemin Crystals, 43 

Esbach's Albuminometer, 46 

Renal Epithelial Cells, 48 

Epithelial Cells, Urethral and Yaginal, 48 

Hyaline and Epithelial Casts, 49 

Waxy Casts, 50 

Granular Casts, 50 

Crystals of Cystin, 52 

Leucin and Tyrosin, 52 

Calcium Oxalate, 53 

Microorganisms, 54 

Johnson's Picro-saccharometer, 60 



TABLE OF CONTENTS. 



PAGE 

Color of Urine, 18 

Specific Gravity, 21 

Normal Constituents, 22 

Normal Organic Constituents, 22 

Urea, 23 

Uric Acid, 28 

Hippuric Acid, 31 

Normal Inorganic Constituents, .32 

Chlorides, Phosphates and Sulphates, 34 

Abnormal Constituents, 37 

Biliary Pigments and Acids, 38 

Pyuria, 39 

Chyluria, 40 

Haematuria and Hsemoglobinuria, 41 

Albuminuria, 44 

Urinary Sediments, 47 

Tube Casts, 49 

Glycosuria, 54 

Lead and Mercury in Urine, 61 

Dietrich's Table, 63 



vu 



THE EXAMINATION OF THE URINE. 



Which are the objective points in the examination of urine 
for clinical purposes ? 

The quantity, appearance, color, odor, reaction, specific gravity, 
increase or decrease of normal ingredients and presence or absence of 
abnormal or adventitious substances. 

When should the specimen be obtained for examination? 

For qualitative purposes the specimen may be taken at any time 
of the day, the morning urine in preference. For quantitative ex- 
amination a specimen of the total urine in 24 hours must be used. 

How is the total urine of the 24 hours to be collected ? 

The urine passed at a certain hour is to be thrown away, all sub- 
sequently passed up to the same hour of the next day is to be col- 
lected in a clean glass jar or bottle and the amount measured. 

How soon thereafter should the urine be examined, and why? 

Shortly after the specimen is obtained,, as putrescence will rapidly 
set in, which will change the character of some of the ingredients. 

What is the average daily quantity voided under normal 
conditions ? 

1200 to 1500 c.c, or about 40-50 fluidounces. 

Under which normal conditions is this increased or di- 
minished? 

Copious drinking increases the quantity ; also, a lower tempera- 
ture or great humidity of the atmosphere ; free sweating, purgation 
or emesis will diminish it. 

Which pathological conditions increase the quantity and 
which diminish it ? 

Diabetes insipidus and diabetes mellitus largely increase the quan- 
2 17 



18 EXAlVnNATION OF URINE. 

tity, acute febrile affections diminisli it. It is also increased in cer- 
tain nervous affections and diminished in hydropic conditions and 
some renal diseases. 

In which way is the appearance of the urine to be noted ? 

If clear, turbid, or containing a sediment. 

Which are the principal causes of turbidity or sedimentation 
in the urine ? 

The presence of mucus, precipitation of the earthy phosphates 
from alkaline reaction, separation of urates by lower temperature, 
and pathologically the presence of pus or fat in minute subdivision, 
the latter causing a layer to rise to the surface. 

What is the normal color of urine, and how are the varia- 
tions expressed ? 

The normal color of urine is yellow, the variations being expressed 
by Vogel's scale, which contains three yellow, three red and three 
brown tints, termed respectively pale yellow, light yellow, yellow, 
reddish-yellow, yellowish-red, red, brownish-red, reddish-brown, 
brownish-black. (See Frontispiece.) 

Which are the normal urinary coloring bodies? 

Indican and urobilin ; others frequently described are modifications 
of the latter. 

How is urobilin derived ? 

From the blood ; the haemoglobin changing to haematin, this to 
bilirubin, which by taking up hydrogen is changed to hydro-bilirubin, 
identical with urobilin. 

What is indican, and how derived ? 

This is sometimes called uroxanthin, and is chemically potassium 
indoxyl-sulphate, a normal component of the urine, varying in quan- 
tities, and derived from disturbances of intestinal digestion and con- 
sequent absorption of the indol of the faeces. 

How is the presence of indican in the urine demonstrated, 
and how determined ? 

Indican can be demonstrated by mixing urine with about i quan- 
tity of HCl, when, upon standing 24 hours, a red, purple, or blue 
color will appear, which if shaken out with chloroform and the sepa- 



COLOR AND ODOR OF URINE. 19 

rated solution compared with a standard solution of indigo in chloro- 
form diluted to the same tint, may be expressed in the quantity of 
indigo it represents. 

What is the color of urine in icterus, and by what produced ? 

The urine in this condition is of a yellow or greenish, or even 
greenish-black color, caused by the presence of biliary coloring matter. 

How may the presence of blood in the urine affect its color ? 

It will cause a change of color from light red to brown and almost 
black. 

Do medicinal agents change the color of the urine ? 

Many of them do : Thus, it is turned brown or black after inges- 
tion of carbolic acid and gallic acid, yellow after santonin, rhubarb 
(changed to red by addition of ammonia), also, after senna, logwood, 
etc. 

What pathological condition gives rise to a dark brown or 
blackish color of urine, and why ? 

Melanotic tumors, owing to the elimination by the kidneys of 
uromelanin, a black coloring body corresponding to the choroidal pig- 
ment. 

Describe the odor of fresh normal urine. 

Fresh normal urine has a specific, not disagreeable, aromatic odor, 
due to the organic acids of the aromatic series. 

How does this change on standing ? 

The urine turns alkaline in reaction, and then ammoniacal decom- 
position takes place, giving rise to a disagreeable ammoniacal odor. 
This may take place already within the bladder in cystitis. 

In what conditions and by which medicines or food is the odor 
of the urine modified ? 

In diabetes the urine has often a fruity odor, due to acetone. 
Asparagus gives it a disagreeable odor. Spirits of turpentine an 
odor not unlike violets. Copaiba, cubebs, balsam of tolu and oil of 
sandalwood give it an aromatic odor. 

What is the effect of mineral acids, and what of fixed alka- 
lies on the normal odor of the urine ? 

Mineral acids interfere with the normal odor, fixed alkalies make 
it aromatic. 



20 EXAMINATION OF URINE. 

Has the urine containing blood a special odor? 

It has a slightly putrid odor, resembling that of high game. 

What is the reaction of normal urine ? What due to ? 

It is normally slightly acid, due to the presence of acid sodium 
phosphate. The acid reaction is greatest in the urine of the night, 
less in that voided after meals. 

How is the reaction of the urine ascertained ? 

If blue litmus paper is touched with a drop of acid urine it will 
be turned to a red color ; if the urine is alkaline, it will turn red 
litmus paper blue. If, upon exposure in the latter case until dry 
the red color is restored, this alkalinity is due to ammonia. 

In which way is the degree of acidity of urine determined ? 

By acidimetrj^ i. e. , titration with a deci normal solution of potas- 
sium hydrate, expressing the result in the corresponding amount of 
oxalic acid. 

What is the relation of the acidity of urine to disease ? 

Many diseases show a direct relation with it. Thus, in typhoid 
fever the acidity is in direct ratio with the fever, in rheumatism with 
the pain, while in pneumonia, pleurisy, emphysema, etc., the urine 
is very acid. 

Which systemic conditions may cause an alkaline reaction of 
the urine ? 

Fear, nervous affections, etc., may bring about alkalinity. Irre- 
spective of food, it is associated with anaemia, debihty, etc. This 
alkalinity is due to fixed alkalies. 

Under what local conditions may the urine become alkaline ? 

In cystitis the urea is decomposed into ammonium carbonate, 
which renders it alkaline, with ammoniacal odor. 

What effect has the alkaline reaction on the urine ? 

The alkalinity from fixed alkalies causes the precipitation of the 
earthy phosphates, rendering it of white color. Ammoniacal alka- 
lescence brings about the formation of triple-phosphate. 

How do medicinal agents influence the reaction of the urine ? 

Mineral acids do not directly influence its reaction ; alkaline hy- 
drates and carbonates render it less acid or alkaline ; the salts of the 



SPECIFIC GRAVITY OF URINE. 



21 



Fig. 1. 



vegetable acids, being eliminated as alkaline carbonates, produce alka- 
linity ; benzoic acid or alkaline benzoates are converted into hippuric 
acid and increase the acidity of the urine. 

What does the specific gravity of the urine represent? 

The amount of solids contained in solution therein. 

State the average specific gravity of normal urine and its 
variations under various conditions. 

The average specific gravity of the normal urine is 
between 1015 and 1025. When great quantities of 
liquids are ingested it may fall to 1002, and when great 
amounts of fluids are withdrawn it may reach as much 
as 1040. 

In which diseases is the urine characteristically 
high, and in which relatively low ? 

In diabetes mellitus it is always high, and may reach 
1050 ; in the various forms of Bright' s disease, as well as 
in amyloid degeneration of the kidneys, it is low, reaching 
1005 to 1004. 

How is the specific gravity of urine ascertained? 

With the urinometer (Fig. 1) ; fill the cylinder for that 
purpose about three-quarters full, then carefully float the 
urinometer in it and add enough urine to fill the cylinder 
to the top, reading ofi" the degree of immersion over the 
top of the liquid. For veiy accurate determinations, the 
specific gravity should be taken with the specific-gravity 
bottle. 

For what purpose does the knowledge of the specific 
gravity of urine serve ? 

For the approximate determination of the quantity of 
solids. Thus, if by Trapp's formula the last two figures 
of the specific gravity are multiplied by 2, it gives the 
amount of solids contained in ] 000 parts ; (the factor 2. 33 is some- 
times used as being more accurate, but 2 suffices for chnical pur- 
poses). 



22 EXA3IINATI0N OF URINE. 

The Normal Constituents of Urine. 

What constitutes the normal solid components of urine ? 

The products of retrograde metamorphosis of nitrogenous bodies, 
together with the inorganic matter ehminated as waste material by 
the kidneys from the circulation. 

How are they classed according to their chemical character, 
and what are they respectively ? 

They may be classed as organic, which form the greater part, and 
inorganic. The principal ones of the former class are urea, uric acid, 
hippuric acid, kreatinin, xanthin, sarkin, oxalic acid, oxaluric acid, 
aromatic ethyl-sulphuric acids, sulphocyanic and succinic acids, 
sugar, lactic acid, pigments, and extractives. The inorganic are 
chlorides, phosphates and sulphates of potassium, sodium, ammo- 
nium, calcium and magnesium, ii'on, silicic acid, nitrites and nitrates, 
also hydrogen peroxide. 

Are these constant in proportion, and what influences their 
presence in the urine ? 

They are subject to continuous change : thus, a more liberal animal 
diet increases the amount of urea ; age, sex and great exertions in- 
fluence their amount as well as pathological conditions. 

Normal Organic Constituents of the Urine. 

Which is the principal solid ingredient of the urine, and 
what is it ? 

Urea, a carbonyl diamide, often termed carbamide (CON2H4), the 
ultimate product of oxidation of the albuminoids introduced into or 
composing the body. 

How much urea is excreted under normal conditions daily ? 

500 grains, or about 30 grammes, which, however, may vary ac- 
cording to the character of the ingested food. 

How may the urea be separated and demonstrated from the 
urine ? 

By acidulating the condensed urine either with nitric or oxalic 
acid, and allowing the nitrate or oxalate of urea to ciystallize from this. 



NORMAL ORGANIC CONSTITUENTS OF URINE. 



23 



"Under which pathological conditions is the elimination of 
urea increased ? 

In febrile conditions which do not suppress the renal action. Thus, 
it is increased in meningitis, typhoid fever, smallpox, erysipelas, in- 
termittent fevers, pneumonia, pleurisy, articular rheumatism with 
endocarditis, etc. 
What pathological conditions diminish the urea in urine ? 

A diminished nutrition, especially of albuminoids, processes of 
suboxidation, such as emphysema, valvular disease of the heart and 
disturbances of the circulation, in which the amount of urea pro- 

FiG. 2. 




a, urea ; b, rhombic, and c, hexagonal plates of urea nitrate. 

duced is less ; in other diseases, such as ascites and anasarca, the urea 
is not secreted, though produced, and is withheld in the circulation ; 
also in cholera and diseases characterized by renal inaction, when with 
an amelioration the urea reappears. The wasting diseases, such as 
anaemia, leucoc3^h8emia, phthisis, acute yellow atrophy, etc., are 
also accompanied by a diminished amount of urea in the urine. 

Can urea ever exist as a sediment in urine ? 

On account of its ready solubility it can never exist as such. 

How can urea he recognized under the microscope ? 

By evaporating a drop of urine cautiously on a slide, when, with 
a low power, the rhombic prisms of urea may be readily recognized 
(Fig- 2). 



24 EXAMINATION OF URINE. 

How may the oxalate or nitrate of urea be prepared ? 

By acidulating condensed urine with either oxahc or nitric acid, 
when the respective oxalate or nitrate will crystalHze out on cooling, 
in hexagonal plates (Fig. 2). 

By what chemical test may urea be recognized ? 

By the Biuret reaction. This consists of heating a specimen of 
urea until it ceases to give off ammoniacal vapors ; when to the 
residue a little potassium hydrate is added and a drop of cupric sul- 
phate solution, the color is changed to a reddish violet. 

Which are the principal agents to break up urea ? 

Stronger mineral acids and hydrates of the alkalies cause it to take 
up water and split up into carbon dioxide and ammonia. Nitrous acid 
splits it into carbon dioxide water and nitrogen, as do also the alka- 
line hypochlorites and hypobromites. Certain microorganisms also 
cause it to break up into ammonium carbonate. 

What is Fowler's method for determining the amount of 
urea in urine, and how applied ? 

The differential density test. To apply this, the specific gravity 
of the urine is first accurately determined and noted and then the spe- 
cific gravity of the specimen of liquor sodae chloratae (Labarraque's 
solution) to be employed. The latter is multiplied by 7 and the 
product added to the amount of the sp. gr. of the urine ; the sum 
so ascertained is divided by 8, which gives the sp. gr. of a mixture 
of 1 part of urine and 7 parts of the hypochlorite solution. After 
this add 1 part urine to 7 parts of Labarraque's solution, and after 
standing for an hour or two, take the specific gravity of the mixture 
after the reaction has been completed. This specific gravity sub- 
tracted from that first computed for the mixture of the two before 
reaction, and the difference multiplied by 0. 77 gives the percentage 
of urea in the urine examined. 

What is Liebig's method of determining urea by titration? 

The method depending on the formation of an insoluble com- 
pound of mercuric nitrate with urea, and the computation of the 
amount of urea from a standardized mercuric nitrate solution used 
for this purpose. 



NORMAL ORGANIC CONSTITUENTS OF URINE. 



25 



Which are the reagents and apparatus used in this method ? 

A standardized mercuric nitrate solution, of which each c.c. is 
equal to 1 centigramme urea. A baryta mixture of 1 part satu- 
rated solution of barium nitrate and 2 parts cold saturated baryta 
water. 

A saturated solution of sodium carbonate, a graduated burette, a 
volume pipette, watch-glasses, glass rod and beaker glass (Fig. 3). 

Fig. 3. 




Burette-stand and Burettes. 



How are the sulphates and phosphates and carbonates first 
separated in this process ? 

By mixing 40 c.c. urine with 20 c.c. baryta mixture, after which 
the liquor is filtered and 15 c.c. is measured into a beaker glass ; 
these 15 c.c. correspond to 10 c.c. urine. At times, if the urine 
contains an excess of phosphates or alkaline carbonates, it becomes 
necessary to take more baryta mixture, and then the specimen to 
be examined must be increased always so as to represent 10 c.c. urine. 



26 lEXAMINATION OF URINE. 

In which manner is the titration of the urea performed, and 
how is the indicator applied ? 

The mercuric solution is dropped from the burette into the filtered 
urine, amidst constant stirring, until it ceases to produce a precipitate ; 
then a few drops are taken out into a watch-glass and an equal amount 
of the soda solution allowed to flow into it. When the resulting reac- 
tion begins to show a yellow color, the saturation is complete, if not, 
more of the mercuric solution is dropped from the burette as above. 

How is the result now computed ? 

As each c.c. of the mercuric nitrate solution is equal to 0.01 
gramme urea, as many as were necessary to saturate it were con- 
tained in 10 c.c. urine, or ten times that amount constitutes the per- 
centage of urea ; from the number of c.c. of mercuric solution 2 c.c. 
are first to be deducted to allow for the sodium chloride which also 
enters into this process. Thus if 30 c.c. were used, 28 c.c. would 
represent 0.28 gramme urea contained in 10 c.c. urine, or 2.8 would 
be the percentage. 

If albumin is present what has to be done first ? 

The urine must be faintly acidulated with acetic acid, and then the 
albumin, coagulated by boiling, is separated by filtration before the 
titration of the urine. 

"What are the principles of the azotimetric method for the 
determination of urea in urine ? 

The urea of the urine is decomposed by a solution of sodium hypo- 
bromite (Knop's solution), thus liberating the nitrogen of the urea 
while the water remains and the carbon dioxide is arrested by the 
alkaline test solution. The nitrogen is then corrected for tempera- 
ture, atmospheric pressure and tension of aqueous vapor, and the 
amount of urea corresponding to each c. c. thereof is equal to 0. 0027 
gramme. 

What comprises the most simple apparatus for this process ? 

A flask containing 15 c.c. hypobromite solution and also a test 
tube standing slantingly in it, into which 5 c. c. urine are added. The 
flask is connected by a rubber tube to an inverted burette or cylin- 
der graduated into c. c. ; this latter is contained in a cylinder filled 



NORMAL ORGANIC CONSTITUENTS OF URINE. 27 

with water and is immersed therein to the zero mark, so that the water 
in the graduated tube and the cyhnder are on an equal level. 

How is the Kiiop's solution made ? 

Dissolve 100 grammes sodium hydrate in 250 c.c. water and add 
25 c.c. bromine. 

How is the process applied ? 

By allowing the urine to commingle with the hypobromite solu- 
tion, when the reaction will take place ; as the N escapes into the 
graduated cylinder the latter is raised so as to keep the water inside 
and outside always on the same level. When the reaction is com- 
plete and no more gas given off the number of c.c. are read off. 

How is the volume of N so observed corrected and how the 
urea computed from it? 

The volume of nitrogen so observed has to be corrected for tem- 
perature, barometric pressure and tension of aqueous vapor. As 
1 gramme urea yields 370 c.c. nitrogen at 0°C. and 7G0 mm. pressure 
the formula for correction of its observed volume is as follows for 
100 c.c. urine : 

100 v. (b — V ) 

^ ~" 760. 370. X. (1 + 0.00366.t) 
In this formula 

U stands for percentage of urea to be determined. 

V the volume of nitrogen read off. 

b barometric pressure. 

b^ tension of aqueous vapor. 

X the measure of urine employed. 

t the temperature (C°) at which the process is conducted. 
Instead of this correction the corrected weight in milligrammes for 
each c.c. nitrogen maybe taken from Dietrich's table by entering 
with barometric pressure from above and the temperature from the 
side, when the corrected weight will be found at the intersection of 
the two lines. (See Dietrich's table on last page.) 

Thus if 10 c.c. N were observed at 15° C. and 740 mm. pressure, 
each c.c. N would weigh 1.1399 milligramme, or 10 = 11.399, 
which if multiplied with 2.14 would give the amount of urea in the 
urine used 24.39388 milligrammes, which if it had been 5 c.c. is 
multiplied with 20 gives the percentage = 0.49. 



28 EXAMINATION OP URINE. 

Does the method give absolutely correct results ? 

No, the theoretical amount of N is never obtained ; this may be 
rectified by multiplying the result with 1 . 044, but even then it is not 
absolutely correct. 

What modifications of the above described apparatus may 
be used for clinical purposes ? 

Such apparatus as that of Lyon, which contains on the cylinder, 
instead of c. c. , subdivisions corresponding to the percentage of urea 
at a temperature of 70° F. Pressure and tension of aqueous vapor 
may be then neglected if the temperature is at or about 70° F. 

What is uric acid ? 

A bibasic acid of the formula C5H4N4O3 which in the form of 
salts is a normal ingredient of the urine and next to urea the prin- 
cipal eliminant of nitrogen from the body ; the quantity eliminated 
under normal conditions during 24 hours amounts from about 0. 5 to 
1 gramme. 

"Under which normal and abnormal conditions is the amount 
of uric acid in the urine increased or decreased ? 

Nitrogenous food increases and carbohydrates diminish the uric 
acid in the urine. In diseases of the respiratory and circulatory sys- 
tem, as in pneumonia, capillary bronchitis, pleuritic exudations, 
pericarditis, etc. , the amount in the urine is increased, also in most 
fever processes. Chronic diseases are accompanied by a diminished 
amount of uric acid in the urine ; it is diminished also after profuse 
hemorrhages and in anaemia, chlorosis, spinal and renal afi'ections, as 
well as in chronic rheumatic and gouty conditions. During the ex- 
acerbations of malarial fevers there is an increase in the elimination 
of uric acid, as well as in typhoid fever, inflammatory rheumatism, 
smallpox and in septic fevers. 

How is uric acid separated from urine? 

By acidulating 500 grammes urine with 10 grammes hydrochloric 
acid, when, after standing 24 hours, the uric acid will crystallize from 
it all but a very small amount held in solution. 

What are the physical properties and microscopical appear- 
ances of uric acid separated from urine ? 
Uric acid is very little soluble in water, about 1 to 18,000, insoluble 



NORMAL ORGANIC CONSTITUENTS OF URINE. 



29 



in alcohol and ether, readily soluble in the neutral alkaline phos- 
phates and carbonates. The crystals separated from the urine ap- 
pear to the naked eye as small reddish-brown particles. Micro- 
scopically they present a variety of shapes which, however, may be 
regarded as modifications of rhombic plates. The most frequent of 
these are the whetstone or lozenge form rounded off at their obtuse 
angles ; other forms resemble barrels, sheaves, rosettes, combs, etc, 
(Fig. 4). 

Is free uric acid ever present in the urine ? 

It may be present in the urine under abnormal conditions at mic- 
turition, when it may give rise to the formation of urinary concretions. 

Fig. 4. 



,.^^ 




a. Rhombic crystals of uric acid, of whetstone or lozenge shape. 6. Barrel shaped, 
c. Sheaves, d. Rosettes of whetstone shaped crystals. 



Which are the principal salts of uric acid present in the 
urine ? 

The salts of the alkalies and alkaline earths ; these form both 
neutral and acid salts, the neutral salts being more frequent in normal 
urine and are more soluble than the acid salts ; the acid sodium urate 
and potassium urate appear frequently as sediments in the acid urine 
of catarrhal and rheumatic affections and in fevers, and have a red- 
dish color, owing to the presence of uroerythrin (lateritious deposits). 
They may be recognized by being redissolved in the urine on heating 
and on addition of alkaline hydrates, also by the microscope as pre- 



30 



EXA^nNATION OF URINE. 



senting an amorphous granular appearance, as in accompanying cut 
(Fig. 5). The acid ammonium urate is often found in alkaline urine 
together with triple phosphate and presents the shape of yellow 
spheres with one or more hooklets attached, often occurring in 
attached pairs (Fig. 6). Ammonium urate is present in some vesical 
concretions and when preformed in the bladder may be the cause 
thereof. 

Ey which test may the presence of uric acid*be shown, and 
how is it applied ? 

By the murexide test ; this consists in dissolving in an evaporating 



Fig. 5. 



Fig. 6. 




Acid sodium urate. 



Triple phosphate and ammonium urate. 



dish a small quantity of the substance to be examined in a few drops 
of nitric acid, and evaporating over a moderate heat to dryness. If 
the dry residue is touched with a drop of ammonia water or exposed 
to its vapors the bright purple color of murexide will appear if uric 
acid was present. 

How is the amount of uric acid in urine determined ? 

By acidulating 200 c.c. urine with 10 c.c. HCl and setting it aside 
for 48 hours. The crystals which have separated are now collected 
on a weighed filter and well washed with cold water ; the filter is 
then dried until it ceases to lose weight, and for each 100 c.c. fluid 
employed 0.0038 gramme uric acid is to be added to the increase of 



NORMAL ORGANIC CONSTITUENTS OF URINE. 



31 



weight over that of the empty filter, which gives. approximately the 
amount of uric acid present. 

What is hippuric acid ? 

A normal monobasic acid of the urine, of the formula C9H9NO3, 
which may be regarded a benzoyl glycocin, as it splits up into ben- 
zoic acid and glycocin. 

In what amounts is it present in the urine and under what 
conditions may this be increased ? 

About 0. 5 to 2. grammes are excreted during 24 hours in the 
urine, which is increased by vegetable and diminished by animal 

Fig. 7. 




Hippuric acid. 



diet. Benzoic, cinnamic and quinic acids are converted in the body 
into hippuric acid and excreted as such. It is said to be increased 
in diabetes mellitus, also in hepatic affections and in jaundice. 

State the physical properties and microscopic appearance of 
hippuric acid. 

It is readily soluble in alcohol, less so in ether, and dissolves only 
in 600 parts of water ; it crystallizes in colorless, long, four-sided 
rhombic prisms, which frequently form stellate bundles (Fig. 7). 

What is kreatinin ? 

A constant component of the urine, of the formula C4II7N3O, 



32 EXA]\nNATION OF URINE. 

supposed to be derived from the kreatin of the muscles. About 1 
gramme is daily excreted under normal conditions and mixed diet. 

State its properties. 

. It is a basic body which, when pure, forms colorless, prismatic 
crystals, soluble in 1 1 parts of water, and readily soluble in alcohol. 
In alkaline solutions it changes to kreatin, which, with acids, loses 
H2O, and forms again kreatinin. 

Under which pathological conditions is it increased, and 
under which decreased ? 

In acute diseases, especially typhoid fever, pneumonia, etc. , it is 
increased in quantity ; in anaemia, chlorosis, marasmus, tuberculosis, 
and progressive muscular atrophy it is diminished. 

What are xanthin and sarkin? 4,^ 

Extractives of the urine closely allied in chemical composition to 

uric acid, 

CsH^NA, C^H^NA, QH^N.O, 
(uric acid.) (xanthin.) (sarkin.) 

but of no cUnical interest. 



Normal Inorganic Constituents of the Urine. 

Which are the principal ones of these ? 

The chlorides, phosphates, and sulphates, which are principally 
derived directly from the food, but the latter two also result as 
oxidation products from albuminoids and other bodies which con- 
tain phosphorus and sulphur. 

Name the most important inorganic salts. 

The one which occurs in largest quantities is sodium chloride, next 
is sodium acid phosphate, also, calcium and magnesium phosphates, 
the sulphates of sodium and potassium, and traces of iron 'and 
silicic acid. 

What is the normal amount of chlorides excreted in 24 hours, 
and what is their importance ? 

The sodium chloride, which is the principal one of them, is 
excreted to the amount of about 16.5 grammes in the 24 hours, vary- 



NORMAL INORGANIC CONSTITUENTS OF URINE, 33 

ing with the quantity ingested. A considerable amount is always 
retained in the circulation, serving probably the purpose of cell- 
nutrition by facilitating the osmotic process. A surplus appears in the 
urine. 

ITiider which pathological conditions are the chlorides in the 
urine decreased ? 

They decrease in all acute febrile diseases, and may, indeed, disap- 
pear altogether, to reappear with convalescence. Especially is this the 
case in diseases accompanied with exudations and transudations, 
which retain the surplus chlorides until their formation is complete. 
Thus we find the chlorides diminished in pneumonia, pleurisy, peri- 
carditis, peritonitis, meningitis, also in typhoid fever and rheumatic 
fever. A decrease of chlorides in the urine is also marked in the 
nephritis accompanied with albuminuria and dropsy. During the 
paroxysms of malarial fever the excretion of chlorides is increased. 

What are the indications for prognosis of a decrease or re- 
appearance of the chlorides in the urine ? 
A considerable diminution or disappearance makes the prognosis 
grave, their reappearance favorable, which is again disturbed by 
their decrease during convalescence. 

How may the chlorides in the urine be shown and their 
quantity be approximated ? 
To a specimen of urine in a test tube add a few drops of nitric acid, 
and then of a solution of silver nitrate sufficient until no more pre- 
cipitate forms. The precipitate will be dense and. curdy if the 
chlorides are present in normal quantities, milky if diminished, and 
faint if almost or entirely absent. If the bulk of the precipitate is 
compared with that of a normal specimen, the relative amount 
may be approximated. 

How are the chlorides in the urine determined by volumetric 
analysis ? 

To do so accurately 10 c.c. urine are evaporated to dryness in a 
porcelain dish and incinerated with 2 grammes pure potassium nitrate 
until the charred organic matter is burned off. The residue is now 
dissolved in about 50 c. c. distilled water and acidulated with dilute 
nitric acid, the excess of which is neutralized by the addition of a 
3 



34 EXAMINATION OF URINE. 

little pure calcium carbonate ; a few drops of neutral potassium 
chromate are then added as indicator. 

The chlorides are now titrated with a standardized solution of sil- 
ver nitrate, each c. c. of which corresponds to 0. 01 gramme sodium 
chloride. The silver nitrate solution is added from a burette to the 
canary-yellow fluid until a slight change to orange shows the com- 
plete precipitation of the chlorides. For each c.c. of the former 
count then 0.01 NaCl, or ten times that amount, to get the percent- 
age. 

Thus, if 10 c.c. urine were used and 15 c.c. AgNOs, the amount 
in 10 c.c. would be 0.15 grammes, or the percentage 1.5. 

May the process of incineration and subsequent acidulation 
be dispensed with for clinical purposes ? 
Yes ; unless the urine is alkaline, very highly colored or albumi- 
nous. If such is not the case the 10 c. c. urine should be diluted with 
40 c.c. distilled water, a few drops of neutral potassium chromate 
added and then titrated and computed as above. As the result is 
generally too great, 1 c. c. is, however, deducted from the quantity 
of silver nitrate solution used. 

In which compounds is phosphoric acid present in the urine ? 

As phosphates of the alkalies and alkaline earths, of which there 
are two-thirds of the former and one-third of the latter. The phos- 
phates of the alkahes are principally present as sodium acid-phos- 
phate, to which the acid reaction of normal urine is due ; those of the 
alkaline earths as phosphates of calcium and magnesium. The total 
quantity of phosphoric acid normally eliminated in 24 hours is between 
2 and 5 grammes. 

From what is the phosphoric acid of the urine derived ? 

From the food and also from the retrograde metamorphosis of tis- 
sues containing phosphorus. Thus it is diminished on fasting, and 
increased by animal diet. 

Under which pathological conditions is the phosphoric acid 
of the urine increased or diminished ? 
In the beginning of the febrile processes, the P2O5 is usually di- 
minished, and decreases still more with fatal termination. With 
defervescence and convalescence the amount is increased, while in 



NORMAL INORGANIC CONSTITUENTS OF URINE. 35 

chronic conditions no constant relations have been established, though 
the earthy phosphates are no doubt increased in cerebral affections, 
rheumatism, osteomalacia, rachitis, whereas a decrease has been 
established in chronic spinal disease, renal affections and dropsy. 

How can the earthy and how can the alkaline phosphates of 
the urine be separated ? 

If an alkahne hydrate, KOH or XaOH, is added to urine, and 
the mixture heated to the boiling-point, the earthy phosphates are 
thrown out and may be filtered off. If to the clear filtrate about 
one-third of magnesia mixture is added, the alkaline phosphates 
will be precipitated as ammonium-magnesium phosphate, termed 
triple-phosphate. 

How does triple-phosphate form from ammoniacal urine in 
cystitis or putrid urine ? 

From the decomposition of urea into ammonium carbonate ; this, 
with the magnesium phosphate, forms ammonium-magnesium phos- 
phate. 

What is the import of triple-phosphate in the urine, and what 
its appearance under the microscope ? 

Triple-phosphate, if formed in the bladder, may give rise to the 
formation of concretions, and as they result from ammoniacal 
urine, cystitis probably exists. Under the microscope, the crystals 
of triple-phosphate are prismatic and highly refractive, representing 
the form of coffin lids, after which they are named. (See Fig. 6, 
page 30.) 

What is the deposit resulting from urine alkaline from fixed 
alkalies ? 
The earthy phosphates — i. e. , phosphates of calcium and magne- 
sium — appearing under the microscope as granular masses. They 
have no tendency to form concretions. 

How is the phosphoric acid of the urine quantitatively 
approximated? 

By Teissier's method: Into a cylinder graduated in c.c, add 50 
c.c. urine and 15 c.c. magnesia mixture ; mix well and allow to settle 
for twenty-four hours. The total P2O5 will be precipitated as triple- 



36 EXAMINATION OF URINE. 

phosphate ; each c. c. , by volume, represents about 0. 03 per cent, of 
phosphoric acid, or about double that amount of phosphates. 

Describe the method for the volumetric determination of 
phosphoric acid in urine. 

This is effected with a standardized solution of uranium acetate, 
eachc.c. of which indicates 0.005 grm. P2O5. To 50 c.c. filtered 
urine, contained in a porcelain capsule or a flask, are added 5 c.c. 
acidulated solution of sodium acetate (sodium acetate 10, acid acetic 
dil. 10, water to 100). These are heated to the boiling-point, and, 
while boiling, the uranium acetate solution is gradually added from 
a burette. When the precipitate has formed, the fluid is tested 
from time to time by letting a few drops run into a solution of 
potassium ferrocyanide. As long as no change of color occurs, the 
process is not finished, and more uranium solution is added. When, 
on testing, a reddish-brown color begins to appear, all the phosphoric 
acid has been precipitated. To compute the result, multiply the 
number of c.c. uranium solution with 0.005, which gives the P2O5 
in 50 c. c. urine, and double that amount the percentage. 

What is the quantity of sulphuric acid eliminated in 24 
hours, in which form, and where derived from ? 
About 2 grms. are eliminated in 24 hours, partly as sulphates of 
the alkalies, and a small portion as organic sulpho-acids. The sul- 
phates are derived directly by ingestion and also by elaboration in the 
body of sulphur into its acid. 

Under which conditions are the sulphates of the urine 
increased, and under which diminished ? 
Animal diet and exertion increase the sulphates in the urine; 
this is also the case in acute diseases, while in chronic affections 
of the kidneys, they are, as a rule, diminished. Ingestion of 
sulphur or sulphur compounds increases the amount of sulphates 
in the urine. 

How are the sulphates in the urine shown? 

By treating urine acidulated with a few drops of nitric acid with 
solution of barium chloride, which will give a precipitate of barium 
sulphate, insoluble in water or acids. 



ABNORMAL CONSTITUENTS OF THE URINE. 37 

Describe the method for determining the sulphuric acid of the 
urine. 

This is accomplished by volumetric analysis with a standard solu- 
tion of barium chloride, each c.c. of which is equal to 0.01 grm. SO 3, 
in the following manner : — 

100 c.c. urine are acidulated with 20 drops hydrochloric acid and 
heated to the boiling point, when the standard barium solution is 
gradually dropped in from a burette until fresh additions show but a 
slight precipitate. This is allowed to settle, and into the clear super- 
natant fluid one drop added. If no further precipitate results, it 
must be tested for an excess of the barium chloride with one drop 
of a sodium sulphate solution. If this shows an excess of barium, 
the determination has to be made with another 100 c.c. of the same 
urine, using less barium solution, and thus until neither the latter 
nor the sodium sulphate show an excess. The standard solution 
contains 30.5 grms. BaCl2 in 1000 c.c, and each c.c. is equal to 
0.01 SO 3. Thus if 13 c.c. BaCl2 was used, the percentage of 
SO3 was 0.13. 



Abnormal Constituents of the Urine. 

What are abnormal constituents of the urine ? 

Bodies which are not found in normal urine and owe their 
presence therein to abnormal, i. e. , pathological conditions. 

Which are the principal abnormal constituents ? 

Biliary pigments, biliary acids, pus, blood corpuscles, haemoglobin, 
albumin, glucose, oxalic acid as calcium oxalate, cystin, leucin and 
tyrosin, together with certain epithelial cells and casts. 

Biliary Pigments and Acids in the Urine. 

How is the appearance of the urine affected by the presence 
of biliary coloring matter ? 

The color is changed to a deep yellow, yellowish green, or even 
brownish green and brown ; it froths freely on being shaken ; the 
froth persists longer than usual, and is of a yellowish green, or 
brownish color. 



38 EXAMINATION OF URINE. 

From which pathological conditions results the presence of 
biliary matters in the urine ? 

From icteroid conditions, which may be caused by either hepato- 
genous or haematogenous icterus. In the former, resulting from 
obstruction of the bile ducts, biliary coloring matter as well as biliary 
acids are present in the urine ; in the latter, consequent upon the 
formation of bilirubin in the blood itself by the destruction therein 
of some of the red corpuscles, biliary coloring matter is found present 
but never biliary acids. 

Which is the principal test for biliary coloring matter in the 
urine, and how applied ? 

Gmehn's test ; on the addition of yellow nitric acid to some urine 
contained in a test tube, in a manner to cause the two to form 
different layers, there will be a play of colors from green, blue, 
violet, red, to yellow, if biliary coloring matter is present ; as non- 
biliary urine sometimes gives off colors with this reaction, it should 
be closely noted that the colors appear in regular order, and that 
green should always form first. 

What other convenient method or modification may be em- 
ployed in its stead ? 

To mix a little urine in a test tube with an equal quantity of a 
saturated solution of sodium nitrate. Hold this slantingly and allow 
some concentrated sulphuric acid to run through the mixture and to 
the bottom of it, when even the smallest traces of bihary coloring 
matter may be detected, as above. 

How may the biliary coloring matter be separated and 
shown? 

By shaking the suspected urine with chloroform, separating the 
yellowish chloroform and applying the nitric acid test, as in Grme- 
lin's method. 

What other bile ingredients are at times found in icteroid 
urine? 

Biliary acids are found in the urine of hepatogenous icterus, but 
never in that of the haematogenous variety. They are not always 
readily shown directly from the urine, and will then need a separa- 
tion therefrom. 



PYURIA. 39 

Which is the principal test for biliary acids, and how 
applied? 

Pettenkofer's test. This consists in adding to some urine a small 
quantity of cane sugar and overlaying witli this some sulphuric acid, 
contained in a test tube, when, if biliary acids are present, there will 
appear a purple zone at the junction of the two liquids. A better 
way is to dip a piece of filtering paper into the saccharated urine, 
allow this to dry and then touch it with sulphuric acid, when biliaiy 
acids will give a purple color. This test may also be made by evapo- 
rating some of the urine, with a minute quantity of cane sugar, to 
dryness in a porcelain dish. If a drop of sulphuric acid added thereto 
gives rise to purple coloration, biliary acids are present. 

How is Oliver's test applied for biliary acids, and what is the 
composition of the reagent ? 

The reagent consists of 30 grains powdered meat peptone, 4 grains 
salicylic acid, 30 minims strong acetic acid, and water sufficient to 
make f^viij. If this is added to urine containing biliary acids a 
turbidity will arise in proportion to the amount of acids present. 
This may also be shown by overlaying the urine with the reagent, 
when the acids give rise to a turbid zone at the junction of the two 
liquids. 

Pyuria, 

What is pyuria and its import ? 

Pyuria is the condition characterized by the presence of pus in the 
urine. It points toward the existence of an acute or chronic inflam- 
mation in the urinary tract, or the communication therewith of ab- 
scesses. The sudden appearance of large quantities of pus in the 
urine would point to the latter condition. Inflammatory conditions 
of the bladder and renal pelvis are accompanied by more or less pus 
in the urine. When considerable pus is present in the bladder and 
the urine strongly alkahne, it will form a viscid jelly, which cannot 
be readily evacuated. 

How may pus in the urine be differentiated from mucus ? 

Pus is turned gelatinous and ropy by caustic alkahes, while mucus 
is liquefied by them with white flakes. 



40 



EXAMINATION OF URINE. 



Which is the most definite method for detecting pus in the 
urine ? 

In the acid urine pus appears as a heavy deposit, which, if in- 
spected under the microscope, shows the pus cells as round, opaque, 
granular spheres, larger than the red corpuscles ; on the addition of 
a drop of acetic acid to the slide, the granular contents and the cell 
membranes disappear, and the nuclei are readily seen (Fig. 8). 



Fig. 8. 




Pus Corpuscles and Epithelial Cells. 

By what chemical test can pus in the urine be detected ? 

By Donne's test. This consists in separating the settled deposit 
by decantation and adding to the sediment a small piece of potas- 
sium hydrate, when, upon stirring, the pus will turn a clear and 
tough gelatinous mass. 



Chyluria. 

What constitutes chyluria, and what are its causes ? 

The presence of fat in the urine, which gives it more or less a 
milky or opalescent appearance ; on standing and separation the fat 
particles rise to the surface. It may be of parasitic origin, as in 
tropical countries, owing to the presence of filaria sanguinis hominis 
or distoma haematobium in the blood, the lymph and the urine. The 



HiEMATURIA AND HEMOGLOBINURIA. 4l 

non-parasitic form is met with occasionally in moderate climates, and 
its origin is attributed to degenerative changes of the kidneys. 

How is the presence of fat in the urine demonstrated ? 

By shaking it with ether and allowing the separated ether to evapo- 
rate, when fat will be found if there has been any present. The 
shaking with ether will not clear up the urine entirely, as the ether 
will precipitate some of the albumins present in chylous urine. To 
thoroughly exhaust the fat in the urine, some potassium hydrate 
solution should be added beforehand. 



Haematuria and Haamoglobinuria. 

What constitutes haematuria ? 

The presence of blood in the urine, as evident from the existence 
of intact red corpuscles therein. 

In which morbid affections may blood be present in the 
urine? 

If large quantities are present, it will most probably come from 
the urinary tract otherwise than the renal parenchyma. Thus in- 
flammatory or hyperaemic conditions of the renal pelvis, ureters, 
also ulcerations, cancer of, or stone in the bladder, may give rise to 
a considerable amount of blood in the urine. If small quantities only 
are found present, it is more likely of renal origin, and if in addition 
to the blood corpuscles renal casts are found in the urine, its origin 
from the kidneys and the existence of parenchymatous nephritis is 
almost certain. 

How does the blood in the urine differ in appearance accord- 
ing to the part of the urinary tract it is derived from ? 

That from the renal parenchyma is well mixed with the urine and 
gives it a smoky appearance ; if from the ureters, it is present in long 
semicircular clots and strings ; the blood from the bladder and urethra 
is generally more in quantity, bright red, and settles in the mine as 
clots. 

By which means is the existence of haematuria confirmed? 

By the detection of the red blood corpuscles under the microscope. 



42 



EXAMINATION OF tlRlNE. 



To this end a small quantity of the sediment, after subsidence, is 
spread upon a microscopic slide with a drop of the urine, when, on 
inspection, the corpuscles will be brought to view in their character- 
istic biconcave spherical form, either single or grouped in rouleau 
form, or they may be crenated, as in dense urine ; if they have im- 
bibed much water, as in urine of low specific gravity, they may 
be swelled up and have lost their biconcavity, and they may have 
partly lost their contour and be partly destroyed, if the urine is 
ammoniacal (Fig. 9). 

Fig. 9. 



l.^ 




Blood Corpuscles.— a, with biconcave depressions; 6 and c, contracted and crenated; 

rf, swollen. 



What constitutes haemoglobinuria? 

The presence of haemoglobin in the urine in a diffluent condition, 
and not in its corpuscular state. 

How is haemoglobinuria caused ? 

By a solution of the stroma of the red corpuscles in the blood leav- 
ing the diflPusible haemoglobin in solution therein which is secreted 
by the kidneys. The solution of the corpuscular element is noted in 
certain diseases, as in scurvy, typhus, pernicious malaria ; also as the 
efibct of certain poisons, such as hydrogen arsenide, phosphorus, 
carbolic acid, and by pressure ; a periodical form is observed, the 
cause of which has as yet not been ascertained. 



H^xMATURIA AND HJEMOGLOBINURIA. 43 

By which simple test may the presence of haemoglobin in the 
urine be demonstrated ? 

By slightly acidulating some of the urine in a test tube with acetic 
acid and raising it to the boiling point. As haemoglobin contains 
coagulable albumin, this will coagulate, and will, on subsiding, be 
found as a reddish sediment at the bottom, the soluble haemoglobin 
having changed to insoluble haematin. 

How can the haemoglobin of the urine be demonstrated by 
the spectroscope ? 

By placing it in the light entering the prism of a spectroscope, it 




Teichmann's Haemin Crystals. 

will give rise to two dark absorption bands in D and E of the spec- 
trum, i. e. , in the yellow and in the green, the former being narrower, 
the latter broader. 

Which is the chemical test for haemoglobin ? 

Almen's test : Add a few drops fresh tincture of guaiac to the 
specimen of urine contained in a test tube ; after agitation add a few 
drops of old spirit of turpentine or ozonic ether (ethereal solution of 
hydrogen peroxide) ; if haemoglobin is present, the color will change 
to a distinct blue. 



44 EXAMINATION OF URINE. 

In which manner may the presence of haemoglobin be most 
definitely and positively established? 

By -the production of Teichmann's crystals of haematin hydro- 
chloride, often termed haemin. To this end the sHghtly acidulated 
urine is boiled, and the coagulum filtered ofi" ; a small portion of this 
is dried with a gentle heat on a microscopic slide ; to the diy residue 
a trace of common salt (XaCl) is added and well mixed with it, and, 
after adding one or two drops of glacial acetic acid on the mixture, 
this is covered with a cover glass, and heated over a lamp to the 
boiling point of the acid ; after cooling, and on examination under 
the microscope, there will be found present numerous flat, rhombic 
prisms or tables, of a brown or blue color, which are haemin, or better 
termed haematin hydrochloride (Fig. 10). 



Albuminuria. 

Which are the albumins found in the urine of albuminuria ? 

Principally serum-albumin, but also, and rarer, paraglobulin. 

Under which conditions may albumin appear in the urine ? 

When the blood is surcharged with albumin, as after excessive in- 
gestion of albuminoids ; if the blood is much diluted, when oedema- 
tous exudations will take place ; when the blood pressure in the 
kidneys is abnormally increased ; also, if the chlorides of the blood 
are wanting, as well as if blood or pus is admixed with the urine. 

Which pathological conditions are accompanied by temporary 
albuminuria ? 

The acute febrile afibctions, such as typhoid fever, diphtheria, 
pneumonia, etc., also the exanthematous diseases during their 
efflorescence. 

When is the presence of albumin in the urine more persistent? 

In the various inflammatory^ afi'ections of the kidneys, variously 
termed Bright' s disease of the kidneys, also in heart and respiratory 
diseases. 

What are the general appearances of albuminous urine ? 

As a rule it is of pale color, low specific gravity, and when shaken 
maintains its froth for some time. 



ALBUMINURIA. 45 

How is urine tested for albumin by Heller's test ? 

To a small quantity of urine in a test tube some nitric acid is added 
by allowing it to flow down tbe sides of the inclined test tube, so that 
the two fluids form separate layers ; if albumin is present there will 
appear at their line of contact a white zone of coagulated albumin. 
This may be also the result of the presence of urates, but in this 
case the white zone is not as distinct and more toward the surface of 
the urine. If warmed, the urate cloud will disappear, but not the 
albumin. 

In which way is the boiling test performed ? 

In this test the urine should be clear, and has to be filtered if tur- 
bid ; if it is neutral or alkaline it has to be made slightly acid by the 
addition of a drop or more of acetic acid. If the upper part of the 
urine in the tube is now heated to the boiling point, it will be ren- 
dered turbid if albumin is present, and may readily be contrasted 
with the clear layer at the bottom. If the total volume is boiled, 
the entire albumin therein will be coagulated, and the flocculent co- 
agulum may be separated by filtration. ..Should too much acetic 
acid have been added, the coagulation may have been prevented by 
the formation of acid-albumin. This can be demonstrated and cor- 
rected by the addition of a few drops of potassium ferrocyanide 
solution, when the coagulum will form at once. 

How can the boiling test be utilized to approximate or com- 
paratively estimate the quantity of albumin for clini- 
cal purposes? 

By allowing the coagulated albumin of the total urine in the test 
tube to subside for 24 hours and expressing the volume of the coagu- 
lum in comparison with the total urine boiled, as, for instance, i or 
i albuminous layer. 

How can picric acid be utilized for detecting albumin in 
urine ? 

If a concentrated solution of picric acid is added to urine there will 
be a coagulum formed if albumin is present. As this may, however, 
be caused also by alkaloids or peptones, this test can be used for the 
exclusion of albumin only, but if found present, it should be con- 
firmed by either of the preceding tests. 



46 



EXAmNATION OF URINE. 



Fig. 11. 



In which way may the picric acid test be used for the quan- 
titative estimation of albumin in the urine ? 

By the use of Esbach's albuminometer (Fig. 11). 
This consists of a test tube of strong glass, marked near 
its middle and upper end respectively U and R, and near 
the bottom with small graduations marked respectively 
1,2, 3, 4, 5, 6, 7. It is used by filling up the tube 
with urine to the letter U and adding an acidulated 
picric acid solution to R. After 24 hours the coagu- 
D i| i||! lated albumin which has settled is read ofi" in grammes 
^ ■ ill'' of dry albumin per litre according to the small gradua- 
tions to which it has settled. To obtain the percent- 
age of dry albumin the respective figure is divided by 
1 0. When the albumin is so abundant that the sedi- 
ment is above 4, a more accurate result is obtained by 
first diluting the mine with one or two yolumes of 
water and then multiplying the resulting figures by 2 
or 3, as the case may be. 

'K ^ \ ill 

How is the acidulated solution of picric acid for 

this process prepared ? 

op III Dissolve 10 grammes picric acid and 20 grammes 
^ Jil ill! citric acid in 800 or 900 cubic centimeters of boil- 
ing -vtater, which, on cooling, bring up with water to 
one htre (1000 C.C.). 

Describe the volumetric estimation of albumin in 
the urine. 

This consists of adding to 10 c.c. of urine 2 c.c. acetic 
acid, diluting with a little water, and then allowing 
Tanret's solution to drop in, drop by drop, from a suit- 
able pipette, counting the number of drops so used ; 
when the precipitate thus formed grows less, a drop 
of the urine is taken out and brought in contact with 
^^minome^^r^^" ^ ^^^ drops of 1 per cent, corrosive sublimate solution 
on a porcelain plate ; if on mixing the two a red pre- 
cipitate occurs, the reaction is complete, and for each drop so used, 
less 3 drops allowed for excess, 0.5 gramme of dry albumin per 
htre are present. 




EPITHELIAL CELLS IN URINARY SEDIMENTS. 47 

Give the composition of Tanret's reagent ? 

3.32 grammes potassium iodide, 1.35 grammes mercuric chloride, 
dissolved in 100 c.c. distilled water. 

Is the presence of albumin in the urine alone sufficient for the 
diagnosis of Bright's disease? 

Xo : as various other causes, already emimerated, may cause tem- 
porary or pseudo-albuminuiia. If the amount of albumin, however, 
is large and persistently present, if the urine also contains casts 
and renal epithehum, the evidence points to the existence of renal 
disease. 



Epithelial Cells in Urinary Sediments. 

Are epithelial ceUs normally present in the urine, and, if 
present in larger quantities, what do they indicate ? 

Epithelial cells are always present in the urine, but according to 
their form, and the greater ciuantity present, they indicate patho- 
logical conditions of certain parts of the urinary tract. 

What form have the epithelial cells of the uriniferous tubules ? 
They have a spherical, granular form, with faint outlines, but 
clearly defined nuclei. They may be present either singly or agglu- 
tinated as epithehal casts. The loops of Henle are hned with 
tessellated epithehiim. and the straight tubules with the columnar 
variety (Fig, 12). 

Which epithelial cells are derived from the renal pelvis ? 

Tessellated epithehum consisting of biconvex and caudate cells. 
The biconvex are generally as long again as they are broad. The 
caudate cells have an ovoid or club-shaped body ending in a fine 
point ; theii' nuclei are well defined (Fig. 12). 

Which epithelial cells belong to ureters and bladder ? 

The ureters have regular tessellated epithelium, composed of poly- 
gonal cells, with central and clearly defined nuclei. The bladder has 
epithelium arranged in layers, of which the upper layer is formed 
by flattened polygonal cells ; the deeper layers have a more spherical 
appearance (Fig. 13). While the female urethra has the same 
epithehum, that of the male ui'ethra resembles more the renal 



48 



EXAmNATION OF URINE. 



epithelium. Renal epithelium is subject to pathological changes, 
such as fatty or amyloid degenerations, recognized by the microscope 
and the amyloid reactions. 



Fig. 12. 




Renal epithelial cells and epithelial cells from renal pelvis. 




Epithelial cells, a, from male urethra; 6, from vagina; d, from Cowper's glands; 
e, from Littre's glands; /, from female urethra; ^, from bladder. 



TUBE CASTS IN THE URINE. 



49 



Tube Casts in the Urine, 

Under what conditions are tube casts found in the urine, and 
how recognized ? 

In acute and chronic renal affections, tube casts may be recognized 
in the urinary sediment by means of the microscope. The sediment 
should be allowed to settle, and a specimen removed with a pipette 
for microscopic inspection. To make them more distinct a drop of 
Lugol's solution or aniline red may be added. 

Which are the principal forms of tube casts? 
The epithelial casts, composed of coherent epithelial cells of the 

Fig. 14. 




Hyaline casts, also one epithelial cast. 

tubes of Bellini ; they are generally pale and transparent, and around 
them small round cells and nuclei may be recognized (Fig. 14). 

The hyaline casts appear as pale, transparent cylinders of various 
sizes and configurations, and of very delicate outlines ; they are also 
termed mucous casts (Fig. 14). 

A modification of these with distinct outlines, slightly yellow 
color and waxy lustre are termed waxy casts (Fig. 15). 

Granular casts (fibrinous casts), resemble the hyaline casts but 
have granular contents consisting of cells which have suffered granu- 
lar change, giving them a darker appearance than the former. They 
4 



50 



EXAMINATION OF URINE. 



may contain, also, oxalates, blood and pus corpuscles, fat globules 
and epithelial cells (Fig. 16). 



Fig. 15. 




Granular casts with fatty globules; also, blood and pus corpuscles, and epithelial 

cells. 

Have the diiFerent tube easts always positive value for dif- 
ferentiating the various renal affections? 
Not always, as in acute and chronic nephritis, as well as in amyloid 
degeneration, all the varieties may be present at one time. 



TUBE CASTS IN THE URINE. 51 

When will they be of such diagnostic value ? 

When one variety only appears. Thus, if epithelial casts alone 
persist for several days, they point to the existence of a desquama- 
tive nephritis with favorable prognosis, while the simultaneous pres- 
ence of pus corpuscles renders the prognosis less favorable. 
In which cases of nephritis are hyaline and granular casts 
found? 

In the severer cases with a disposition to chronicity, as indicated 
by their number and persistence. If they contain numerous fat 
granules and fat globules the diagnosis of fatty degeneration is 
justifiable, especially if accompanied by fatty degenerated renal epi- 
thelium both in the casts and separately. 

What would indicate the existence of the contracted kidney? 

If the tube casts grow thinner and the epithehal elements appear 
contracted. 

How may amyloid degeneration be indicated ? 

The tube casts may here appear the same as in the other forms of 
nephritis, but there will be found besides the fatty degenerated epi- 
thelial cells, also such as have undergone amyloid degeneration, recog- 
nized by being colored red by methyl-violet, the others turning blue. 

What would blood casts show? 

That there is renal hemorrhage, the casts being coagulated blood 
with imbedded corpuscles. 

Which are some of the other abnormal sediments of the 
urine of clinical interest ? 

Cystin, leucin and tyrosin, calcium oxalate and micro-organisms. 

When and in what form is cystin found in the urine ? 

Cystin is found occasionally, but very seldom, as urinary concre- 
tion, also in urinary deposits ; it is insoluble in water, not dis- 
solved by heating, but soluble in alkaline hydrates, also mineral 
and oxalic acids. Under the microscope it appears in the form of 
colorless, shining, six-sided plates or prisms (Fig. 17). 

When and how do leucin and tyrosin occur in urinary sedi- 
ments ? 

They occur frequently in the urinary sediments in acute yellow 
atrophy of the liver, also in phosphorus poisoning, and point to an 
incomplete oxidation of the albuminoids. 



52 



EXAMINATION OF URINE. 



What is the microscopical appearance of leucin? 

Yellow-colored spheres, at times concentrically striated with pro- 
truding delicate points or spines (Fig. 18). 



Fig. 17. 




Crystals of cystin {after Ultzmann), 



Fig. 18. 







(a) Leucin, spheres; (6) Tyrosin, needles and sheaves. 

How does tyrosin appear under the microscope ? 

Tyi'osin, which appears generally associated with leucin in urinary 
sediments, has the form of silky, white, microscopic needles which are 
arranged in sheaves or stellate form (Fig. 18). 



URINARY SEDIMENTS. 



53 



In what compound is oxalic acid occasionally present in the 
urine? 

As calcium oxalate, which is frequently found in the urine, but 
becomes of importance only when pre-sent in larger quantities and 
persistently, when it gives rise to oxaluria, signifying a retarded 
metabolism or suboxidation. 

Describe the form of crystals of calcium oxalate in urinary 
sediments. 

It forms minute, transparent, briUiant octahedra presenting some- 
what the shape of a square envelope. At times the crystals assume 

Fig. 19. 




Calcium oxalate in octahedral (envelope) crystals; also in dumb-bells ; some larger 
crystals of uric acid. 



the form of dumb-bells ; to detect them a high power objective 
should be employed (Fig. 19). 

Under which conditions are micro-organisms found in the 
urine ? 
As a rule, micro-organisms are found in the urine only after it has 
been exposed to the air for some time, but they may be carried into 
the bladder by catheters or sounds, and there set up ammoniacal 
decomposition of the urea, giving rise to cystitis. Of greater 
importance are those which are derived from the blood, as in 



54 EXAmNATION OF URINE. 

infectious diseases, sucli as scarlatina, typhoid and malarial fevers 
and renal diseases. 

Which are the principal micro-organisms found in the urine ? 

Mould (penicillium), yeast cells, sarcinae (in tlie urine they are 

smaller than of the stomach), vibriones, bacteria, bacilli, cocci, etc. 

(Fig. 20). 

Fig. 20. 




Micro-organisms of urinary sediment. 



Glycosuria. 

Is sugar normally found in urine, and in what quantities ? 

Sugar as glucose is found normally in the urine in veiy small 
quantities, not more than 0. 1 gramme in 24 hours. 

If found in larger quantities and persistently, what patho- 
logical condition is present ? 

Glycosuria or diabetes mellitus ; it may, however, be found in 
the urine in larger quantities in cerebral and nei-yous affections ; 
also temporarily after anaesthesia from chloroform, ether, etc., as 
well as after copious ingestion of sugar. 

What is the appearance and physical condition of the urine 
of glycosuria ? 

It is much increased in quantity, and may reach one or two 
gallons in the 24 hours ; it is of pale or pale yellow color, often 



GLYCOSURIA. 55 

slightly greenish, clear, as a rule, but may contain sediments of urates 
or oxalates ; it has a high specific gravity, generally between 1030 
to 1040 and even more; the urea eliminated is abnormally increased. 

Which foods increase and which diminish the amount of 
glucose in the urine ? 

Starchy and saccharine food increases, and animal diet decreases 
the amount. 

In testing urine containing albumin for glucose, what has to 
be done first ? 
The albumin has first to be separated by boiling and filtration. 

Describe Moore's test for the detection of glucose in urine. 

In a long test tube mix about one part of urine with half its 
volume of liquor potassae. Heat the mixed liquids in its upper half 
until active ebullition ensues, when, if glucose is present, the upper 
part will turn dark yellow to reddish brown. If the whole volume 
is thus treated, it will change color in a similar manner, and if then 
some nitric acid is added, it is decolorized and an odor of burnt sugar 
is given off. 

What effect has glucose on certain metallic oxides if heated 
together in a strong alkaline fluid? 

The metallic oxides, especially those of bismuth and copper, are 
reduced ; the former to metaUic bismuth, the cupric oxide to 
cuprous oxide. 

Describe Boettger's test. 

Boettger's, or the alkaline bismuth test, is performed by mixing 
equal parts of urine and liquor potassae and adding a small quantity 
of bismuth subnitrate ; boil for a minute or two, and if glucose is 
present, the bismuth will turn gray, brown or black, owing to the 
reduction to its metallic state. 

What are the advantages and disadvantages of this test ? 

It has the advantage that uric acid, urates and kreatinin do not 
affect it, but albumin or sulphides present in the urine, produce 
similar effects as glucose. 

What is Nylander's modification of the alkaline bismuth 
test? 
This consists in the use of a single alkaline bismuth solution 



56 EXAMINATION OF URINE. 

composed of bismutli subnitrate 2 grammes, Rochelle salt 4 
grammes, solution of sodium hydrate (8 per cent.) 100 grammes. 
To 10 c.c. urine 1 c.c. of this solution is added and the two boiled 
together ; if glucose is present, it turns brown or black. 

Upon what reactions do the alkaline cupric tests depend ? 

First, that on adding a few drops of cupric sulphate solution to 
liquor potassae a greenish-blue precipitate of cupric hydrate is 
formed. 

CuSO, + 2KH0 -= Cu(0H)2 + K2SO4. 

Second, the cupric hydrate on boiling splits up into cupric oxide 
and water, the former aj)pearing as a black precipitate. 

Cu(0H)2 = CuO + H2O. 

Third, the black precipitate does not form in the presence of cer- 
tain organic matter and excess of alkahne hydrate, but remains in 
solution, having a deep blue color. When this alkaline cupric oxide 
solution is boiled in the presence of glucose, the latter takes away 
oxygen from the cupric oxide, leaving yellow insoluble cuprous oxide. 

2CuO — O = CU2O. 

Trommer's test, what is it, and how performed? 

To some urine in a test tube add one-half or one-third volume of 
liquor potassae and a few drops of a 10 per cent, solution of cupric 
sulphate. If this is heated in its upper half to the boiling point 
there will be a reddish-yellow turbidity, caused by the separation of 
cuprous oxide, if glucose is present. The two strata will give a dis- 
tinct difference in appearance. 

How can this test be improved by the addition of glycerin? 

The addition of a few drops of glycerin will prevent the precipita- 
tion of the black cupric oxide and admit of the test solution being 
first tested by boiling. If to some liquor potassae in a test tube a 
few drops of cupric sulphate solution are added, and also a few 
drops of glycerin, a clear, deep blue liquid will result. This is 
brought to the boiling point, and after removal from the flame a little 
of the urine is added ; if glucose is present, the characteristic red- 
dish-yellow cuprous oxide will form within a minute or two. If this 
does not take place after the first addition of the urine it should be 



GLYCOSURIA. 57 

brought to the boiHng point again and a little more urine added as 
before. 

Which is the principal alkaline cupric test, and how applied? 

The Fehling's test, an alkaline solution of cupric oxide, which is 
held in solution by Rochelle salt (sodium-potassium tartrate), (see 
formula under quantitative tests for sugar). This solution is di- 
luted with 3 to 4 volumes of water, heated to the boiling point, 
when a little urine is added. If sugar is present, a yellowish-red 
precipitate of cuprous oxide will form ; if indistinct at first, boil 
again and add more urine. The boiling before adding the urine is 
necessary to establish the quality of the solution and to show if it 
does not decompose spontaneously at the boiling point. 

What is the most positive evidence of glucose in urine, and 
how shown? 

The alcoholic fermentation on addition of yeast. This may be 
shown by adding some yeast to a bottle filled with the suspected 
urine. Invert the bottle in a vessel containing the same urine ; if 
inside of 24 hours part of the urine is displaced by carbon dioxide, 
glucose was present. This may be further verified by testing the 
urine for alcohol by adding to the fermented urine a few drops of po- 
tassium dichromate solution and sulphuric acid ; if, on warming, 
a green color appears, alcohol was formed and glucose positively 
present in the urine. 

How may the presence of glucose in urine be shown by 
phenyl-hydrazine ? 

To equal parts of urine and liquor potassae add a few drops of 
phenyl-hydrazine, and heat to boiling. In the presence of glucose 
an intense yellow or orange color develops ; on addition of an excess 
of acetic acid, yellow ciystals are precipitated. 

Which are some other very delicate tests for glucose in urine ? 

The tests with menthol, thymol or alpha-naphthol. These are 
applied by using their alcoholic solutions (1 to 7 alcohol), and mixing a 
few drops thereof with the urine. To the mixture, in a test tube, 
add some sulphuric acid in a manner that they do not mix, when, if 
glucose is present, there will be a red color at the line of contact with 



58 EXAMINATION OF URINE. 

thymol or mentliol, or violet with greenish borders if alpha-naphthol 
was employed. 

How may picric acid be used for the detection of glucose 
in urine ? 

By its conversion, on boiling with an alkaline hydrate, into dark, 
reddish-brown picramic acid if glucose is present. Normal urine pro- 
duces a similar reaction, but not of the deep reddish-brown color as 
when glucose is present. 

By what ready method may the fermentation test for glu- 
cose in urine be used quantitatively ? 

By the differential density method of Roberts. This is conducted 
by accurately taking the specific gravity of the urine to be examined, 
the temperature of the urine being noted. With 4 ozs. of this 
urine in a 12 oz. flask or bottle, mix a small piece (about i cake) of 
compressed yeast ; after setting aside for 24 hours in a warm place, 
fermentation is completed. The urine is then cooled to the temper- 
ature of the former specimen and its specific gravity also accurately 
ascertained. The number of degrees of specific gravity lost by fer- 
mentation corresponds to the number of grains of glucose in the 
ounce of urine. The percentage may be obtained by multiplying the 
number of degrees lost by 0.22. 

How is the quantity of glucose in urine ascertained by polari- 
zation ? 
By filling the container of a polarization apparatus with the filtered 
urine, free from albumin. The urine must be almost colorless, and 
care must be had that no air bubbles are in the tube. The analyzer 
is then moved to accurately correct the difference in color in the two 
halves of the visual field, and the angle through which it was moved 
is read off by means of the scale and vernier. The amount of glu- 
cose is computed by the following formula : p =t~^ ,in which p 

stands for the quantity of glucose in grammes in 1 c.c. of the urine, 
a the angle read off, + 56 the specific rotation for glucose, and 1 the 
length of the containing tube expressed in decimeters. Thus, if 
the angle read off were 4. 5°, the tube 1 decimeter long, it would be 

^^^ = 0.080 glucose in 1 c.c, or 8.0 in 100 c.c. Various instru- 



GLYCOSURIA. 59 

ments for this purpose are in the market, some admitting the read- 
ing off directly of the percentage of glucose. 

Give the formula for making Fehling's solution. 

As Fehhng's solution does not keep, it should not be kept on 
hand for any length of time, but should be made as two separate 
solutions, of which equal amounts by measure are mixed together at 
the time when wanted to form the complete test solution. 

No. 1. R. Cuprie sulphate (pure, not effloresced, 

and free from water of crystallization), 34.64 grammes 
Water, q. s. to 500 c.c. 

No. 2. R. Eochelle salt (crystallized), 173 grammes 

Solution of sodium hydrate, sp. gr. 1.34, 100 c.c. 
Water, q. s. 500 c.c. 

For use, mix equal volumes of No. 1 and No. 2 as needed. 

Describe the method for the quantitative determination of 
glucose in urine by Fehling's volumetric process. 

Place into a capsule, beaker or flask 10 c.c. of Fehling's solution 
diluted with 40 c .c. of water. Heat to the boiling point, and let gradu- 
ally run into it from a burette a mixture of one part of urine and nine of 
water, stirring the mixture, and continue thus until the blue color of 
the test solution has entirely disappeared. The diluted urine is to be 
added in small quantities only, and the test solution must be raised 
to the boiling point after each addition, when it is left to subside for 
a few seconds to be able to view the supernatant fluid with trans- 
mitted hght. Toward the last only a drop or two at the time should 
be added, as the clear shade should have a rather yellowish tint. 
This process should be repeated several times until the amount of 
diluted urine proves the smallest quantity efiecting complete reduc- 
tion. 

How is the quantity of glucose computed from this ? 

As 10 c.c. Fehling's solution are reduced by 0.05 gramme glucose, 
that amount of urine which is present in the dilution which has re- 
duced the 10 c.c. of the Fehling's solution contained 0.05 gramme 
glucose. Thus, if 16 c.c. diluted urine (1 in 10) were used, 1.6 urine 
contained 0. 05 gramme glucose. To obtain the percentage the fol- 



60 



EXAMINATION OF tJRINE. 



100 : X ; X = 3. 1 per 



Fig. 21. 



lowing proportion will answer : 1.6 : 0.05 
cent. 

What is Johnson^s picric-acid test for the quantitative deter- 
mination of glucose in urine ? 

It consists of converting picric acid in the presence of potassium 
hydrate and glucose into reddish-brown picramic acid ; the intensity of 
the color of the latter being proportionate to the amount of glucose 
present ; the color of the picramic acid formed is then compared 
with that of a standardized solution of ferric acetate, and the amount 
of glucose ascertained by the dilution required. 

How is this test performed? 

Take of urine f5j, liquor potassae f5ss, solution of 
picric acid (gr. 5. 3 to fgj) ^^^1, water q. s. ad f5iv into a 
test tube and boil for sixty seconds ; cool the mixture 
and bring it up to the original volume (f^iv). Of this 
pour 10 c.c. into a 100 c.c. graduated cylinder, which 
has attached to it a test tube of equal diameter and con- 
taining the standard fluid (Fig. 21) ; dilute the boiled 
mixture with distilled water to equal in color the standard 
liquid, and for each 10 c.c. it has been distilled up to, 
count 1 grain of glucose in the fluidounce of urine 
tested. 

How may the measurement of the ingredients be 
simplified ? 
By taking 5 c.c. of each, urine, potassium hydrate 
solution (sp. gr. 1.036), solution of picric acid (gr. 3.5 to 
fgj), and water. 

Give the formula for the standard ferric acetate 
solution. 

B. Liquor, ferri chloridi, U. S. P., f.^j 

Ammonii carb., gj 

Acidi acetici, f ^ v 

Aquae destillatse, q. s. ad f ^ iijss. M. 

Is the above formula for the standard fluid reliable, and what 
should be done to make it so ? 

It is not reliable, and to make it so it should be standardized by 





LEAD AND MERCURY IN THE URINE. 61 

comparing it witli urine, to each fluidounce of which 1 grain of crys- 
talHzed glucose has been added. To this the KOH, picric acid and 
water, is added, as above, and boiled for sixty seconds, when, after 
boiling, the standard iron solution is either diluted or made denser 
in color by addition of some liquor ferri chloridi to closely correspond 
in color. By doing so, not only is the error of variable strength of 
the ferric chloride solution corrected, but the error created by the nor- 
mal presence of kreatinin is also overcome. When thus executed, 
this method is as reliable as any other for chnical purposes. 



Lead and Mercury in the Urine. 

Is lead readily detected in urine after lead-poisoning, and is 
a failure to find it proof of its absence from the system? 

Lead is not always found in the urine after lead-poisoning, and is 
not always readily detected. Before testing for lead in the urine, 
iodide of potassium should be administered in fudl doses for a few 
days. 

Give a method for detecting the presence of lead in the 
urine. 

About 30 to 50 ounces of urine are brought to the boiling point in 
a porcelain evaporating dish, and while boiling, nitric acid (free from 
lead) is added in small quantities until on addition no further 
effervescence results ; evaporation is then continued to dryness, the 
residue is carbonized in a porcelain crucible with the addition of 
nitric acid. The residuary mass, after combustion, is boiled out 
with nitric acid ; after boiliti^ it is diluted with water, the mixture 
filtered and the filtrate evaporated to dryness. The dry residue is 
dissolved in water slightly acidulated with HNO3, and a current of 
hydrogen sulphide is allowed to pass through it for some time. If a 
brownish-black precipitate results, the presence of lead should be 
confirmed by testing another portion of the clear fluid with potassium 
iodide or neutral potassium chromate ; with either of these it must 
give a yellow precipitate if lead is present. As the latter are not so 
sensitive as H2S, it maybe necessary to separate the precipitated 
lead sulphide, redissolve by gradual addition of HNO3, evaporate 
excess of latter, and test after dilution and filtration as before. The 



62 EXAMINATION OF URINE. 

lead iodide so derived will be seen under the microscope as six-sided 
plates. If the lead sulphide precipitated is sufficient, it may be 
reduced by the blow-pipe flame to a malleable particle of lead. 

When may the detection of mercury in the urine be of diag- 
nostic value ? 
In cases of protracted mercurialization, as in syphilis, etc. 

Describe a ready method for detecting mercury in urine. 

300-500 c. c. of urine are acidulated with hydrochloric acid and 
evaporated to about one-fourth of its volume, allowed to cool and 
then filtered. In the filtrate boil for a little while a slip of pure, 
bright copper foil ; after boiling sufficiently, take it out, wash off in 
distilled water and dry it between bibulous paper ; then roll up and 
put into an open glass tube ; heat at the place where the copper is 
to redness, when the mercury will be driven to a cooler portion of 
the tube, to be recognized by the shape and brilliancy of its globules 
under the microscope ; also, by converting it into red mercuric 
iodide, when into the hot portion of the tube a minimal fragment of 
iodine is introduced and its vapors are allowed to flow over the sub- 
hmed mercury. 

What other very delicate method may be employed for 
detecting mercury in the urine ? 

The method of Ludwig is the one best adapted for detecting 
mercury in the urine. .It is conducted by acidulating 200-500 c.c. 
urine with hydrochloric acid, warming the mixture to 50°-60° C, and 
adding 5 grammes of pure zinc dust (to be had of dealers in 
chemicals). The mixture is stirred for some time while warm, and then 
the zinc is allowed to subside, when the supernatant fluid is separated 
by decantation ; the metallic sediment is well washed with distilled 
water and dried in a vapor bath after filtration. The mercury, having 
united with the zinc dust to form an amalgam, can now be driven off; 
this is done best in an open tube in which the zinc dust is secured 
by two loose asbestos plugs. The part of the tube containing the 
zinc is now heated and the mercury driven up to the upper and 
cooler portion of the tube. That portion of the tube is broken off, 
and the sublimed mercury is recognized by converting it into red 
mercuric iodide by passing a vapor of iodine over it. 






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63 



INDEX. 



ABNORMAL constituents, 37 
Albumin, approximation of, 45 
boiling test for, 45 
volumetric estimation of, 46 
Albuminous urine, appearance of, 44 
Albuminuria, 44 
causes of, 44 
Alkaline cupric tests, 56 
Alpha-nap hthol test for sugar, 57 
Ammonium urate, 30 
Appearance of urine, 18 
Azotimetric determination of urea, 26 

BILIARY matter, how resulting, 38 
pigments and acids, 37 
Biuret reaction, 24 
Blood corpuscles, 42 
Boettger's test, 55 
Bright's disease, diagnosis of, 47 

pALCIUM oxalate, 53 

V>' Casts, value for diagnosis, 50 

Chlorides, 32 

demonstration and determination 
of, 33 

pathological import, 33 
Chyluria, 40 

Collection of specimen, 17 
Color, 18 
Computation for urea by azotimetric 

method, 27 
Cystin, 51 

rvIETRICH'S table, 63 

EARTHY phosphates, 35 
Epithelial casts, 49 

cells from renal pelvis, 47 
in urinary sediments, 47 
of ureters and bladder, 47 
of uriniferous tubules, 47 
Esbach's method for determination 
of albumin, 46 

5 



FAT in urine, how demonstrated, 44 
Fehling's solution, formula, 59 

Fehling's test, 57 

Fehling's test for quantitative deter- 
mination of sugar, 59 

Fermentation test for determination 
of sugar, 58 

Fermentation test for sugar, 57 

Fowler's method for determination of 
urea, 24 



GLYCERIN-cupric test for sugar, 
56 
Glycosuria, 54 
Grmelin's test, 38 
Granular casts, 49 

H HEMATURIA, 41 
cause of, 41 
Haemoglobin, chemical test for, 43 

spectroscopic test for, 43 

test for, 43 
Hsemoglobinuria, 41 

cause of, 42 
Heller's test, 45 
Hippuric acid, 31 
Hyaline casts, 49 



fNDICAN, 18 



JOHNSON'S picric acid test, quanti- 
tative, 60 

NOP'S solution, 27 



KNOP'S solution, 
Kreatinin, 31 



LEAD, detection of, in urine, 61 
Leucin, 51 
Liebig's method for determination of 

urea, 24 
Lyon's apparatus, 28 



65 



INDEX. 



MENTHOL test for sugar, 57 
Mercury, detection of, by Lud- 
wig's method, 62 
in urine, 62 
Microorganisms, 53 
Moore's test for sugar, 55. 
Mucous casts, 49 
Murexide test, 30 

NORMAL constituents, 22 
inorganic constituents, 32 
organic constituents, 22 
Nylander's test, 55 

ODOR, 19 
Oliver's test, 39 
Oxalic acid, 53 

PETTENKOFER'S test, 39 
Phenyl-hydrazine test for sugar, 
57 
Phosphoric acid, 34 

quantitative determination 
of, 35 
Picric acid, acidulated solution of, 46 
test for albumin, 45 
sugar, 58 
Polarization for determination of 

sugar, 58 
Pus, 39 

detection of, 40 
Pyuria, 39 



AUANTITY voided, 17 
REACTION, 20 

O ARKIN, 32 

^ Specific gravity, 21 
Sulphuric acid, 36 

determination of, 37 

rpANRET'S reagent, 47 
J- Teichmann's crystals, 44 
Thymol test for sugar, 57 
Triple-phosphate, 35 
Trommer's test, 56 
Tube casts in urine, 49 
Tyrosin, 51 

UREA, 22 
oxalate and nitrate, 23 
Uric acid, 28 

determination of, 30 
microscopic appearance of, 28 
salts of, 29 
Urobilin, 18 

WAXY casts, 49 
VANTHIN, 32 



